This report describes a case involving an 82 year old patient with mild renal insufficiency, severe pulmonary valve stenosis (PVS), severe anterior descending artery stenosis and complete atrioventricular block, who successfully underwent, in a single session, coronary angioplasty and a stent implant, pulmonary valvotomy and a permanent pacemaker implant.Coronary percutaneous interventions with stent implants are extensively used in the treatment of coronary patients, including octogenarians 1-5 . PVS, frequently diagnosed and treated during childhood or adolescence, is rarely found in octogenarian patients. Percutaneous treatment of PVS is a safe and efficient procedure 6 .A cardiac conduction system disease in an octogenarian is common and an indication for a permanent pacemaker implant is frequently recommended.Our report refers to an octogenarian patient with severe PVS, a serious lesion in the mid third of the anterior descending artery and complete atrioventricular block (CAVB). This patient was submitted successfully to three consecutive procedures in the cardiac catheterization laboratory: pulmonary valvotomy, coronary stent implant and permanent pacemaker implant. CASE REPORTThe patient is an 82 year old male in good general condition, with dyspnea for two months, progressively increasing from moderate to mild exertions. A physical examination presented blood pressure (BP) of 150/90 mmHg, cardiac frequency of 60 beats per minute and a systolic ejection murmur ++/4 over the pulmonary area radiating toward the left sternal edge. The chest x-rays show a cardiac silhouette within normal limits, pulmonary vasculature within normal limits, prominent dilation of the pulmonary artery trunk, pulmonary parenchyma within normal limits, blunted cardiophrenic and costophrenic angles. An electrocardiogram, taken ninety days earlier, revealed a sinus rhythm, CF of 60 bpm, SAQRS between 90 and 180 degrees and an increased strain on the right chambers. The laboratory tests presented creatinine levels of 2.3 mg/ml and urea of 60 mg/ml. The echocardiogram revealed severe PVS and an alteration in the left ventricle relaxation phase.The procedure was performed after renal preparation. The patient was adequately hydrated and given 600 mg of N-acetylcysteine every twelve hours, maintaining the drug administration for 48 hours.The hemodynamic study confirmed severe pulmonary valve stenosis with a systolic gradient of 80 mmHg (PT = 20/10 mmHg and RV = 100/8 mmHg). anterior descending artery presented eccentric stenosis, 70% ulcerated in its mid third; the other arteries presented discrete wall motion irregularities. The left ventricle (LV) presented normal contractile function. The renal preparation was performed before the procedure with adequate hydration and previous administration of Nacetylcysteine for 48 hours as well as antiplatelet therapy with ASA and clopidogrel in the normal dosages. There was a reduction in the levels of creatinine and urea to 1 mg/ml and 40 mg/ml, respectively.On the day of the procedure, during ad...